Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | IL |
NPI | 1376549980 |
---|---|
Provider Name | Mr. Douglas E Reichert |
First Address | Kenosha, WI 53144-1771 |
Second Address | Kenosha, WI 53144-1771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 08/07/2007 |